Student Activity Permission/Sign Up

My student has permission to attend the following trip(s):*

eKids Day Camp ~ August 10

Student Name*

First NameLast Name

Student 2 Name

First NameLast Name

Student 3 Name

First NameLast Name

Student Phone Number (if youth event)

Parent Name*

First NameLast Name

Parent Phone Number*

Please enter a valid phone number.

I, {parentName}, being the parent or legal guardian of the student named above, do hereby consent to the participation of my child in the selected event and in all activities that are a part of that event. This includes consent for my student to travel by Encounter Church bussing to all destinations (if part of this trip). If I wish to revoke this consent for any reason, I will promptly notify the leader in writing.

Medical Treatment Authorization I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I give Encounter Church staff permission to call a doctor and to provide necessary medical services in the event that my child is injured or becomes ill.

I understand that Encounter Church will not be responsible for medical expenses incurred solely on the basis of this authorization. I further agree to notify Encounter Church in writing of any health changes that would restrict my youth’s participation in this trip. I also understand that Encounter Church reserves the right to restrict my student from any activity that they do not feel is within the physical capabilities of my child.

Signature*

Please verify that you are human*

My Products

eKids Day Camp

$10.00 Quantity

Total

$0.00

Credit Card

Student Event Registration

Credit Card